The actual house vote is far from the great victory that Pelosi and Democratic leaders declared. The Democrats had a crushing majority, had poll after poll that showed the public wants a real public option and full affordable health coverage for all, and no cuts in the Medicare services (the cuts are in the house and senate bills). Yet, the house bill still barely squeaked through and then only after Pelosi and other house liberals shamefully back pedaled and excised abortion coverage from the bill. This all guaranteed that the resistance to the most liberal provisions of the house bill will be even more ferocious in the senate.
Even if none of these factors came into play in the senate, the senate still more often than not has been the graveyard for house passed legislation that the senate considers too liberal, too pro labor, too expansive, too costly, and too non-industry friendly. In the past couple of years the senate has killed house passed legislation on tougher energy standards, scaling back contributions to the IMF, increased education spending, house amendments on Iraq and Afghanistan troop withdrawal and decreased war spending, and immigration and major banking reforms. It bottled up for years the house passed expanded hate crimes bill.
Industry groups dead set against the house bill have one more trump card, and that's the conference committees. The senate can amend, change the language, or red pencil out anything in a house bill it likes. It then tosses it back to the house to amend, change the language or excise things that the senate wants tossed out. The conference committee negotiations on controversial legislation are long, tedious, and drawn out. When or even if agreement is ever reached it then goes back to both the full body of the house and senate for a vote. There's no time frame for completion for any of this. Nor is there any requirement the senate take a final vote. This was the case with other pieces of "landmark" bills the house passed.
The house vote on health care reform was historic only in that one body of congress took the hotly contested first big step toward reform. The senate hasn't spoken. And it, not the house, is the name of the game on health care reform.
Earl Ofari Hutchinson is an author and political analyst. His forthcoming book, How Obama Governed: The Year of Crisis and Challenge (Middle Passage Press) will be released in January 2010.